How To Diagnose Asthma In Adults

Are There Any Special Considerations For Adults Who Develop Asthma

People with multiple medical conditions need to be aware of how their illnesses and the medications they use may affect one another.

If you take more than one medication, talk with your physician about ways to simplify your medication program. Explore the possibility of combining medications or using alternate ones that will have the same desired effect. Be sure to discuss potential drug interactions with anything you take including vitamins or herbal supplements.

Tests Of Bronchial Hyperreactivity

When spirometry is normal, but symptoms and the clinical history are suggestive of asthma, measurement of airway responsiveness using direct airway challenges to inhaled bronchoconstrictor stimuli or indirect challenges may help confirm a diagnosis of asthma.

Tests of bronchial hyperreactivity should be conducted in accordance with standardized protocols in a pulmonary function laboratory or other facility equipped to manage acute bronchospasm. Bronchopovocation testing involves the patient inhaling increasing doses or concentrations of an inert stimulus until a given level of bronchoconstriction is achieved, typically a 20% fall in FEV1. An inhaled rapid-acting bronchodilator is then provided to reverse the obstruction. Test results are usually expressed as the provocative dose or provocative concentration of the provoking agent that causes the FEV1 to drop by 20% . For methacholine, most pulmonary function laboratories use a PC20 value less than 4-8;mg/mL as the threshold for a positive result indicative of airway hyperreactivity, supporting a diagnosis of asthma. However, positive challenge tests are not specific to asthma and may occur with other conditions such as allergic rhinitis and chronic obstructive pulmonary disease . Therefore, tests of bronchial hyperreactivity may be most useful for ruling out asthma among individuals who are symptomatic. A negative test result in a symptomatic patient not receiving anti-inflammatory therapy is highly sensitive .

Symptoms Like Coughing Wheezing And Feeling Breathless Could Mean You Have Asthma See Your Gp To Confirm A Diagnosis Of Asthma And Start Treatment

Find out why its important to get a diagnosis so you can start treatment for asthma, how asthma is diagnosed, and how you can take positive steps to stay symptom free after a diagnosis.

• tightness in the chest
• feeling short of breath.;

Not everyone with asthma will get all of these. For example, not everyone wheezes. But if youre experiencing one or more of these symptoms, make an appointment with your GP.

Most people with well-managed asthma only have symptoms now and then. But some people have symptoms a lot of the time, particularly the small percentage of people with;severe asthma.

A key thing with asthma is that symptoms come and go – you may not have them all the time.

Why its important to see your GP to confirm a diagnosis;

If youve noticed asthma-like symptoms, dont ignore them. Make an appointment with your GP or an asthma nurse as soon as you can. ;

The quicker you get diagnosed, the quicker you can get the right medicines to help you deal with your symptoms.

Asthma is a long-term condition that needs regular preventer treatment. If its not treated, it could lead to an asthma attack which can be life-threatening.

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What Are Signs And Symptoms Of Adult Onset Asthma

Regardless of age, asthma symptoms can include:

;;;;;;;;;;; Dry cough, especially at night or in response to specific triggers

;;;;;;;;;;; Tightness or pressure in the chest

;;;;;;;;;;; Wheezing a whistling sound when exhaling

;;;;;;;;;;; Shortness of breath after exercise or physical exertion

;;;;;;;;;;; Difficulty breathing

;;;;;;;;;;; Colds that go to the chest or hang on for 10 days or more

What Are Other Conditions A Doctor Might Test For In Someone With Asthma

There are some medical conditions that might make asthma harder to treat and control. Two of these conditions are sinusitis and gastroesophageal reflux disease, commonly called GERD and known as heartburn. If you are diagnosed with asthma, your doctor might also test you for these conditions so that they can be treated.

Sinusitis, also called sinus infection, is an inflammation or swelling of the sinuses due to infection. When the sinuses become blocked and filled with fluid, bacteria grow, causing infection and inflammation. Your doctor might order a special X-ray, called a CT scan, to evaluate your sinuses if he or she suspects an infection. Once acute sinusitis is diagnosed, you will be treated with antibiotics for at least 10 to 12 days.

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What Asthma Feels Like

We will try to demonstrate and explain what asthma feels like.

First, make a tight fist and press it firmly to your lips. Then try to breathe in and then out through your mouth.; You should find it very difficult to breathe. That is exactly what asthma is like.

Another way to describe it is to breathe through a strawyou should be able to breathe easily. Think of the straw as one of the airways to your lungs. Now pinch the straw, so that it becomes narrower. Try breathing in and out through the pinched straw. You will find breathing again much harder that, too is what asthma is like.

Everybodys asthma is unique; some people may have annual asthma attacks each year, when they have real difficulty breathing and have to go to Emergency. For others, who never have an attack, asthma is merely an inconvenience. ; ;

Up to 10% of North Americans will suffer from asthma symptoms in their lifetime. For some, it can be a chronic respiratory condition, an issue they have to deal with most of their lives. On the other hand, children with asthma often lose their symptoms as they grow older.

In spite of the number of sufferers, the increasing numbers of new cases and the constant threat of attacks, asthma is still one of the most misunderstood health issues of the day. False claims about asthma abound: people believe its contagious, or is caused by anxiety, bad parenting, etc. This book dispels these myths and provides you with a positive, controlling outlook on this condition.

Consider Lifestyle Interventions As Well As Pharmacological Treatments

Smoking cessation is as important an intervention in asthma as it is in chronic obstructive pulmonary disease , yet we often fail to recognise this. Research has shown that many people with asthma smoke at levels relatively close to those evident in the general population,13 and we need to remember that this may not just be cigarettes.

Two vaccinations are recommended for some people with asthma. The flu vaccine is advised for patients with asthma who are taking inhaled or systemic steroids, or who have experienced previous exacerbations requiring a hospital admission.14 The pneumococcal vaccine is recommended for patients with severe asthma that requires the use of systemic steroids, and anyone over the age of 65 years.15

Relaxation and breathing exercises can help with symptoms of asthma, especially if people are overbreathing or shallow breathing.2,16 Similarly, anxiety management can help those who overbreathe and are anxious because of their diagnosis or lifestyle.16

Weight loss is important, as is exerciseone important message for people with asthma is that, if controlled, the condition should not limit them from exercise, even at the highest levels.

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If Your Asthma Symptoms Are Caused By Allergies Take Steps To Control Knownor Potential Triggers In Your Environment

Allergy-proof your house for dust, mold, cockroaches, and other common indoor allergens to which you are allergic.

;Reduce your outdoor activities when the pollen count or ozone level is high.

;Choose foods that dont contribute to your asthma or allergy symptoms.

;Evaluate your workplace for possible allergens and take the necessary steps to reduce your exposure to them.

In order to determine relevant triggers, you may want to seek consultation with an allergist who can further define these triggers.

In addition, anyone with asthma should consider getting an annual flu shot. Older adults also should talk with their internist about getting a pneumonia vaccination.

Get The Diagnosis Of Asthma Right By Taking A Good History

A good history will take into account many factors, including childhood respiratory problems, history of allergy, family history of asthma or allergy, occupation and change in occupational working practices, hobbies, pets, housing, changes in circumstances including social circumstances, medication use, comorbidity, and current or previous smoking of tobacco or other substances.1,2 It may also be worth asking about vaping habits as, although vaping is not formally recognised as a trigger for asthma, growing evidence suggests that the use of e-cigarettes causes short-term airway inflammation in patients with asthma.3

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Some People Experience Unusual Asthma Attack Symptoms

Response from Lorene Alba, AE-C

Itâs important to pay attention to your body for these often-subtle warning signs. My chin itches before I have an asthma episode, usually a day or two before. Other warning signs can be restless sleep, feeling tired or moody, having a stuffy nose, or clearing your throat. A drop in your peak flow meter reading is also a warning sign; peak flow meters often show your asthma worsening before you begin to feel symptoms.

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Box 2 Alternative Causes Of Symptoms Suggestive Of Asthma*

• Other obstructive lung diseases

Dyspnea can have respiratory, cardiac, hematologic, neuromuscular or psychosomatic causes, but the pattern of symptoms associated with this problem may point to the specific diagnosis . Distinguishing asthma from chronic obstructive pulmonary disease is a common clinical challenge. Asthma is associated with variable symptoms that often worsen after exposure to triggers and with nocturnal symptoms . In contrast, patients with COPD tend to experience a gradual increase in symptoms over time, with exacerbations often being related to infectious precipitants . Also, COPD is characterized by irreversible or only partially reversible airflow obstruction and results from an abnormal inflammatory response to noxious agents. Asthma and COPD can coexist, particularly in people who smoke., Validated symptom-based questionnaires and diagnostic algorithms, designed for use in countries without the capabilities to objectively measure lung function, can be used to differentiate these conditions.

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Adult Asthma: Diagnosis And Treatment : The Nurse Practitione

What Is The Best Way To Live With Asthma

The key to good living with asthma is developing a strong partnership between patients, caregivers, and physicians. Practical steps include the following:

;; Make an asthma care management plan with your physician. An asthma management plan helps you understand what to do when specific situations arise. Each time you visit the physician, talk about your plan, and make any necessary changes.

;; Educate yourself. Stay informed about the latest developments in asthma and allergy care and treatment. Ask your physician about new medications or research findings that may relate to your care.

;; Get regular medical care. If you have asthma, you should see your physician at least once a year, even if your symptoms are under control. When you become sick, or if you have significant changes in your health, you should also talk with your physician about how your asthma could be affected.

;; Take your medicine. Your asthma medications will make you feel better and sometimes people think thats the time to stop. Its not! Use your medications as prescribed.

With good management, asthma symptoms can be controlled. Most people who develop adult onset asthma are able to lead normal lives. Expect success!

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Pharmacological Treatment Pathway For Adults

This section is for people with newly diagnosed asthma or asthma that is uncontrolled on their current treatment. Where the recommendations represent a change from traditional clinical practice, people whose asthma is well controlled on their current treatment should not have their treatment changed purely to follow this guidance.

1.6.1 Offer a short-acting beta2 agonist as reliever therapy to adults with newly diagnosed asthma.

1.6.2 For adults with asthma who have infrequent, short-lived wheeze and normal lung function, consider treatment with SABA reliever therapy alone.

1.6.3 Offer a low dose of an ICS as the first-line maintenance therapy to adults with:

• symptoms at presentation that clearly indicate the need for maintenance therapy or

• asthma that is uncontrolled with a SABA alone.

1.6.4 If asthma is uncontrolled in adults on a low dose of ICS as maintenance therapy, offer a leukotriene receptor antagonist in addition to the ICS and review the response to treatment in 4;to;8;weeks.

1.6.5 If asthma is uncontrolled in adults on a low dose of ICS and an LTRA as maintenance therapy, offer a long-acting beta2 agonist in combination with the ICS, and review LTRA treatment as follows:

• discuss with the person whether or not to continue LTRA treatment

• take into account the degree of response to LTRA treatment.

1.6.8 If asthma is uncontrolled in adults on a moderate maintenance ICS dose with a LABA , with or without an LTRA, consider:

How Common Is It

Obese patients are known to have more respiratory symptoms than the non-obese, and so one might expect them to have an even greater rate of overdiagnosis of asthma. van Huisstedeet al. examined both over- and under-diagnoses in the morbidly obese by recruiting 86 patients who were undergoing pre-operative screening for bariatric surgery. 32 of the participants had a physician diagnosis of asthma, with the remainder free of an asthma diagnosis. They underwent pre- and post-bronchodilator spirometry, FeNO measurement, impulse oscillometry and a methacholine provocation test. Asthma was diagnosed when symptoms were present in the presence of either significant reversibility in their FEV1 with a short-acting 2-agonist or a positive provocation test. 40% of patients with a prior diagnosis of asthma did not meet these criteria, although it is possible that some of those patients did still have asthma, in particular as not all patients agreed to stop their inhaled therapy prior to testing. Interestingly, underdiagnosis was also present: 31% of patients with no diagnosis of asthma had asthma symptoms plus a positive test. The authors concluded that symptoms were unreliable for an adequate diagnosis of asthma in this population.

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How Can Adult Onset Asthma Be Managed

If you manage your asthma, you can expect to lead a normal lifestyle. Basically, there are four key steps to managing asthma successfully:

1.;;;Learn about asthma and stay up-to-date on new developments.

2.;; Take prescribed medications. Dont make any changes until you check with your physician. Dont use over- the-counter medications unless prescribed by your physician!

3.;; Check your lungs daily at home by using a peak flow meter. Asthma patients often can detect lung changes with a peak flow meter before they actually experience any changes. Visit your physician regularly for further in-office tests. Lung testing is painless and provides valuable data that helps your physician make adjustments in your medication.

4. ;; Make an asthma management plan with your physician. A plan establishes guidelines that tell you what to do if your asthma symptoms get worse.

Breathing Tests For Diagnosing Adult

The breathing tests for asthma include:

• Spirometry how much air you can breathe out in a set time.
• Bronchodilator reversibility this is when two spirometry tests are done before and after a one-off dose of bronchodilator medication to see if the treatment helps. A positive BDR test usually confirms an asthma diagnosis.
• Peak expiratory flow monitoring measures how fast you can breathe out. You might be asked to monitor your PEF, often referred to simply as peak flow, at home for two to four weeks.
• Fractional exhaled nitric oxide measures the level of inflammation in your airways.
• Bronchial challenge investigates how sensitive your airways are to a deliberately administered irritant . This specialist test is only done under medical supervision in hospital.

Most people need just one or two tests to reach a diagnosis. After asthma is confirmed you might have one or more allergy tests to try to identify potential triggers.

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Can Asthma Reappear In Adults After Disappearing Years Ago

Asthma is usually diagnosed in childhood. In many patients; however, the symptoms will disappear or are significantly reduced after puberty. After age 20, symptoms may begin to reappear.

Researchers have tracked this tendency for reappearing asthma and found that people with childhood asthma tend to experience reappearing symptoms through their 30s and 40s at various levels of severity.

Regardless of whether your asthma is active, you should continue to avoid your known triggers and keep your rescue medications or prescriptions up-to-date and handy in case you need them.